Back in Line Systems, LLC
Organization Active NPI Chiropractor · Dallas, GA
NPI 1346572328 · NPPES record last updated Jun 1, 2012
Key facts
- NPI
- 1346572328
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Chiropractor 111N00000X
- License
- CHIRO08541 (GA)
- Legal business name
- BACK IN LINE SYSTEMS, LLC
- Practice address
- 110 Evans Mill Dr Ste 105
Dallas, GA 30157-1643 - Phone
- (770) 505-5665
- NPI assigned
- Feb 2, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Ladonna C Bense, D.C.
- Title
- Owner
- Phone
- (770) 505-5665
Practitioners 1
-
Ladonna C Bense, D.C.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160513001815 | GA | Part B Supplier - Clinic/Group Practice | 7315236304 |
Receives reassigned benefits from 1 practitioner Practice locations: Dallas, GA |
National Provider Directory
Locations
110 Evans Mill Dr
Ste 105
Dallas, GA 30157
Phone (770) 485-6955
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Chiropractor |
111N00000X | CHIRO08541 | GA | Yes |
Addresses
Primary practice location
110 Evans Mill Dr Ste 105
Dallas, GA 30157-1643
Mailing address
110 Evans Mill Dr Ste 105
Dallas, GA 30157-1643
Phone (770) 505-5665
Other providers in Dallas, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 1, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.